Children with juvenile idiopathic arthritis: are health outcomes better for those diagnosed younger?

Background Children living with juvenile idiopathic arthritis (JIA) have swollen, painful and stiff joints, which may have an impact on all spheres of their life, as well as their family. While children diagnosed in their preschool years may be at risk for worse physical outcomes than children diagnosed later in life, it is not clear whether they have worse psychological outcomes and whether these outcomes have an impact on their everyday life. The aim of this study was to examine the association between age at diagnosis and health outcomes in families of children with JIA. Methods Parents of children with JIA (n = 182) who attended rheumatology clinics at the Montreal Children's Hospital and British Columbia Children's Hospital completed measures assessing socio‐demographic attributes, their child's health status, health‐related quality of life and pain level, as well as their own level of psychological distress and coping behaviours. Regression models explored the association between age at diagnosis and health outcomes while adjusting for sex, age, severity and duration of the disease. Results Parents of children diagnosed with JIA before 5 years of age found their child to have a better health‐related quality of life in terms of psychosocial functioning than parents of children diagnosed later [β = ?0.91 (?1.63, ?0.19)]. Children diagnosed younger were also found to be less limited in schoolwork or activities with friends because of emotional or behavioural problems than children diagnosed later [odds ratio = 0.07 (0.01, 0.42)]. Conclusions Children diagnosed younger seem to show good psychosocial adjustment, which may also be true for their caregivers. Perhaps more attention to psychosocial adjustment should be given to families of children who are diagnosed with the disease at an older age.     

Social inequalities and outcomes in type 2 diabetes in the German region of Augsburg. A cross-sectional survey.

Summary Objectives: To assess the association of socioeconomic position with health (care) outcomes in type 2 diabetes with a particular focus on glycaemic control. Methods: A cross-sectional survey in the region of Augsburg (Germany) on 373 men and women with type 2 diabetes, drawn from representative MONICA surveys and the myocardial infarct register. Analysis of association of socioeconomic position with HbA1c levels, cardiovascular risk factors and long-term macro- and microvascular diabetes complications using logistic regression models. Results: Glycaemic control, measured by HbA1c levels, is strongly associated with indicators of socioeconomic position favouring the better off. Comparison of the lowest with the highest socioeconomic group showed an odds ratio of 2.49 (95% CI: 1.22–5.07) for the MI register subgroup and 1.80 (95% CI: 0.80–4.06) for the survey subgroup for failure to achieve the recommended HbA1c target. This association could not be accounted for by differences across social groups in age, sex, diabetes duration, obesity, or physical activity. Conclusions: Social inequalities in glycaemic control do exist. This finding may indicate a level of diabetes care that is inappropriate to the need of socially disadvantaged groups. Submitted: 22 June 2005; Revised: 15 September 2006; Accepted: 13 March 2007     

Diabetes stigma,parent depressive symptoms and Type-1 diabetes glycemic control in India

ABSTRACT

Diabetes distress and stigma have been associated with worse patient outcomes in developed countries. However, diabetes stigma has not been studied in low and middle-income countries where clinical practices differ, diabetes awareness is lower, and families face different challenges for supporting children with Type 1 Diabetes (T1D). This study assessed the relationship between parental depression and diabetes stigma with a child’s glycemic control in a clinic-based survey in Nagpur, India. The association between self-reported T1D stigma, depressive symptoms, and child’s measured glycemic control (HbA1C) was assessed with data from 165 of the parents of school-aged (aged 5+) children receiving clinical T1D care at an urban nonprofit organization that provides free clinical care to children with Type-1 Diabetes (T1D) in India. Parents with moderate/severe depressive symptoms who experience stigma associated with their child’s diabetes had children with significantly worse glycemic control than parents with no/mild depressive symptoms who experience the same amount of stigma. Higher reports of stigma were associated with an average of 0.65 points higher HbA1C (β = 0.65, 95% Confidence Interval (CI): 0.18, 1.13) for parents with moderate/severe than parents with mild/no depressive symptoms. Indian parents with depressive symptoms who face social stigma associated with their child’s diabetes have children with worse T1D outcomes.     

Assessment of Physical Activity Level among Individuals with Type 2 Diabetes Mellitus at Cheras Health Clinic, Kuala Lumpur

A cross-sectional study was carried out to assess the physical activity levels among patients with type 2 diabetes mellitus (DM) at Cheras Health Clinic in Kuala Lumpur. A total of 132 subjects (62 men and 70 women) aged 30 years and above participated in this study. Data was collected using an interview based questionnaire to obtain socio-demographic and health profile information. Physical activity was assessed using a shortened version of the International Physical Activity Questionnaire (IPAQ). Anthropometric measurements and body fat were also taken. Glycaemic status, that is, HbA1c, fasting blood sugar (FBS) and 2 hours post-prandial (2-HPP) were obtained from medical records. Results showed that the mean age of the patients was 51.9 + 5.8 years. The majority of patients had poor glycaemic control based on HbA1c (70.7%), FBS (71.9%) and 2HPP (85.4%). Patients who were unmarried and aged(60 years and above had a lower physical activity level (p< 0.05). In the older age group, low physical activity was associated with poor glycaemic control (p< 0.05). Patients in the moderate and high physical activity level were motivated to perform physical activity so as to be healthy (68.1%). Low physical activity level among patients was due to lack of time (54.5%) and lack of energy (21.2%). In conclusion, physical activity levels of the patients were unsatisfactory and associated with poor glycaemic control, especially in the elderly. There is a need to encourage diabetic patients to undertake regular physical activity in order to achieve optimal glycaemic control.     

Patient Characteristics do not Predict Poor Glycaemic Control in type 2 Diabetes Patients Treated in Primary Care

Many diabetic patients in general practice do not achieve good glycaemic control. The aim of this study was to assess which characteristics of type 2 diabetes patients treated in primary care predict poor glycaemic control (HbA1c > or = 7%). Data were collected from the medical records. 1641 patients were included who had mean HbA1c 7.1(SD 1.7)% , and 42% had HbA1c > or = 7%. On univariate analysis younger age; longer duration of diabetes; higher levels of blood glucose at diagnosis; most recent fasting blood glucose (FBG), total cholesterol, and triglyceride; higher body mass index (BMI); treatment with oral hypoglycaemic agents (OHA); treatment with insulin; more GP-visits for diabetes in the last year; and lower educational level were associated with poor control. Both in multiple linear regression and in multiple logistic regression higher levels of FBG (odds ratio (OR): = 1.6, 95% confidence interval (CI): 1.49, 1.70), treatment with OHA (OR: 2.1, 95% CI: 1.41, 3.04), treatment with insulin (OR: 7.2, 95% CI: 4.18, 12.52), lower educational level (OR: 1.26, 95% CI: 1.01, 1.56) were independently associated with poor levels of HbA1c. When FBG levels were excluded from the model, higher blood glucose at diagnosis, higher values for triglyceride and total cholesterol, and younger age predicted poor glycaemic control, but these variables explained only 15% of the variation in HbA1c. In conclusion prediction of poor glycaemic control from patient characteristics in diabetic patients in general practice is hardly possible. FBG appeared to be a strong predictor of HbA1c, which underlines the usefulness of this simple test in daily diabetes care. The worse metabolic control in those treated with either OHA or insulin suggests that current treatment regimes might be not sufficiently applied to reach the targets of care. Providers of diabetes care should be attentive to patients with lower educational level.     

Hope More,Worry Less: Hope as a Potential Resilience Factor in Mothers of Very Young Children With Type 1 Diabetes

Little research has explored potential resilience factors in parenting a child with a chronic illness—or factors that help protect against the experience of psychological distress. This study explored the relation between hope (a resilience factor) and anxiety (a distress factor) in mothers of very young children with type 1 diabetes. Seventy-five mothers of children aged 2 through 5 years diagnosed with type 1 diabetes completed a self-report assessment battery, including well-standardized measures of hope and anxiety. As expected, analyses indicated an inverse relation between mothers' hope and anxiety. In addition, after controlling for significant medical and demographic covariates, hope remained a negative contributor to maternal anxiety (p < .001). This suggests that having an individual disposition that includes high hope may serve as a protective factor against psychological distress in mothers of very young children with diabetes. Examining levels of hope in this population may identify parents least and most at risk for distress, facilitating the provision of targeted and tailored intervention.     

The psychological consequences of cardiopulmonary resuscitation training for family members of patients at risk for sudden death.

OBJECTIVES: The purpose of this study was to determine psychological consequences of teaching cardiopulmonary resuscitation (CPR) to family members of patients at risk for sudden death. METHODS: Patient-family pairs (n = 337) were randomized into one of four groups: control, CPR only, CPR with cardiac risk factor education, and CPR with a social support intervention. Only family members received CPR training. Data on emotional state and psychosocial adjustment to illness were collected at baseline, 2 weeks, and 3 and 6 months following CPR training. RESULTS: There were no significant differences in the emotional states of family members across the four groups. However, significant differences in psychosocial adjustment and emotional states occurred in patients across treatment groups following CPR training. Patients whose family members learned CPR with the social support intervention reported better psychosocial adjustment and less anxiety and hostility than patients in the other groups. Control patients reported better psychosocial adjustment and less emotional distress than patients in the CPR-only and CPR-education groups. CONCLUSIONS: These findings support tailoring family CPR training so that instruction does not result in negative psychological states in patients. The findings also illustrate the efficacy of a simple intervention that combines CPR training with social support.     

Improving vulnerable school children’s psychosocial health outcomes through resilience-based training and peer-support activities: a comparative prospective study

Sustaining psychosocial well-being is important in promoting coping with life challenges among vulnerable in-school children. There is lack of evidence on intervention that could best help to address psychosocial distress among vulnerable in-school children in Nigeria. The effectiveness of resilience-based training and peer-support activities were compared in 339 vulnerable children selected from public high schools. A comparative prospective design was used. Children were assigned into resilience group and peer-support group randomly using their schools. Analysis of data was done in SPSS version 20 at p < .05 level of significance. Effectiveness of the intervention was evaluated on four psychosocial outcomes (anxiety, depression, self-esteem and social connection). The study concluded that resilience training is better in enhancing self-esteem and reducing anxiety symptoms than peer-support activities. Both interventions have similar effects on depression and social connection. In the face of limited resources to support school health programmes in the study setting, resilience training could be more useful for alleviating psychosocial distress among vulnerable in-school children than peer support activities.     

The associations among economic hardship, caregiver psychological distress, disease activity, and health-related quality of life in children with juvenile idiopathic arthritis

Purpose

To examine the associations among caregiver perceived economic hardship, psychological distress, children??s disease activity, and health-related quality of life (HRQOL) in children with juvenile idiopathic arthritis (JIA).

Methods

Caregivers of 182 children with JIA (ages 2?C18) attending the rheumatology clinics at the Montreal Children??s Hospital and the British Columbia??s Children Hospital completed a series of questionnaires on perceived financial hardship, caregiver psychological distress, and children??s HRQOL at baseline, 6 and 12?months. Clinical information such as disease activity was obtained from medical charts. Statistical models were used to look at the significance of several factors of interest while controlling for possible confounders.

Results

Higher caregiver perceived economic hardship [(???=?0.03, 95% CI?=?0.005, 0.06), P?=?0.02], psychological distress [(???=?0.02, 95% CI?=?0.006, 0.03), P?=?0.004], and higher children??s disease activity [(???=?0.11, 95% CI?=?0.07, 0.15), P?Conclusions Findings suggest that caregiver financial hardship and psychological distress as well as children??s disease activity may impact children??s HRQOL. By providing psychological help to parents, offering information regarding financial resources in the community and by ensuring disease control, especially when the disease is severe, health providers may improve children??s health outcomes.     

Social capital – a neglected issue in diabetes control: a cross‐sectional survey in Iran

Glycaemic control is an essential component in diabetes management. There is growing attention on the protective effects of social capital on health, where social capital comprises features of society that facilitate co‐operation for mutual benefit. The aim of this study was to investigate its role as a social determinant of health in the glycaemic control of diabetes mellitus. A cross‐sectional study was conducted in a diabetes care charity institute, Isfahan, Iran from July 2010 to September 2010. Based on the level of HbA1c, all patients were divided into two groups: HbA1c level ≤ 7 as controlled diabetes and HbA1c level > 7 as uncontrolled diabetes. Sixty patients were randomly selected from each group (controlled diabetes and uncontrolled diabetes) and all agreed to participate. Social capital was measured using the Integrated Questionnaire for the Measurement of Social Capital (SC‐IQ). The mean age of participants in the controlled diabetes group was 51.3 (SD: 7.8) years and 50.1(SD: 7.2) in the uncontrolled group. The mean social capital score was 185.1 (CI 95% 181.4–188.6) in the controlled group and 175.4 (CI 95% 171.8–178.8) in the uncontrolled group. There was a significant negative correlation between empowerment and political action and trust and solidarity dimensions and the level of HbA1c. In multiple regression analysis, trust and solidarity and empowerment and political action were significant predictors of the HbA1c. The results of this study suggest that social participation, trust, and empowerment and political action may determine how effectively the patient’s diabetes has been managed. This initial finding warrants subsequent experimental investigations designed to identify strategies that can be used to foster the creation of social capital to improve diabetes control.     

Factors Associated with Consumption of Diabetic Diet among Type 2 Diabetic Subjects from Ahmedabad,Western India

This cross-sectional study assessed the current situation of and factors associated with consumption of diabetic diet among 399 type 2 diabetes mellitus (T2DM) subjects from Ahmedabad, Western India. The study was performed with diagnosed (at least one year old) diabetic subjects who attended the Department of Diabetology, All India Institute of Diabetes and Research and Yash Diabetes Specialties Centre (Swasthya Hospital), Ahmedabad during July 2010–November 2010. The subjects completed an interviewer-administered questionnaire. The questionnaire included variables, such as sociodemographic factors, family history of diabetes, behavioural profile, risk profile (glycaemic status, hypertension, and obesity), and diet-related history (consumption of diabetic diet, consumption of low fat/skimmed milk, method of cooking, and sources for diet advice). Blood pressure, body mass index, glycosylated haemoglobin (HbA1c) level, and fasting lipid profile were measured. All analyses including multivariate logistic regression were conducted using SPSS, version 11.5. In total, 399 T2DM subjects (65% male, 35% female) with mean age of 53.16±7.95 years were studied. Although 73% of T2DM subjects were consuming diabetic diet, the good glycaemic control (HbA1c level <7%) was achieved only in 35% of the subjects. The majority (75%) of the subjects had a positive family history of diabetes, and 52% were obese. In 77%, the main source of dietary advice was doctor. In 36%, the main methods of cooking were: boiling and roasting. The final multivariate model showed that visit to dietician, level of education, intake of low fat, and family history of diabetes were independent predictors for diabetic diet consumption among T2DM subjects. However, longitudinal and cohort studies are required to establish the association between consumption of diabetic diet and glycaemic control.Key words: Cross-sectional study, Diet, Glycaemic control, Glycosylated haemoglobin, Obesity, Type 2 diabetes mellitus, India     

Glycaemic control in type II diabetic tube-fed patients with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids: a randomised controlled trial

OBJECTIVES: To investigate the effects of long-term treatment with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids (MUFAs), in comparison with a standard formula, on glycaemic control in tube-fed type II diabetic patients. DESIGN: Randomised, double-blind, controlled, multi-centre trial.Setting:Early rehabilitation centres, primary care and nursing facilities. SUBJECTS:A total of 78 patients with insulin-treated type II diabetes with HbA(1C) > or =7.0% and/or fasting blood glucose >6.66 mmol/l, who required enteral tube feeding due to neurological dysphagia. INTERVENTIONS: Patients received 113 kJ (27 kcal)/kg of body weight of either test feed or an isoenergetic, isonitrogenous enteral formula (control) for 12 weeks. Glycaemic control (total daily insulin dosage (IU), fasting blood glucose, and HbA(1C)) and gastrointestinal tolerance were monitored daily. RESULTS: After 12 weeks, median values for changes from baseline were as follows (test group vs control group, 'data as available' analysis): total daily IUs -6.0 vs 0.0 (P=0.0024), fasting blood glucose (mmol/l) -1.59 vs -0.08 (P=0.0068); HbA(1C) (%) -0.8 vs 0.0 (P=0.0016). Both formulas were tolerated comparably. CONCLUSIONS:This study indicates that in tube-fed insulin-treated type II diabetic patients, the new low-carbohydrate, high MUFA formula results in a more effective glycaemic control than the standard diet, while being comparable in safety.     

Annual Psychological Screening in Youth and Young Adults with Type 1 Diabetes

Aim

Youth and young adults with type 1 diabetes are at a great risk for developing depression and diabetes specific distress, therefore, systematic psychological screening is recommended. Routine psychological screening was implemented in Slovene diabetes clinic for children, adolescents and young adults in 2012. One-year results are presented.

Methods

Adolescents and young adults (N = 159, aged 11 – 25 years), attending the obligatory yearly educational outpatient visit at University Children’s Hospital, Ljubljana, Slovenia, were examined using questionnaires measuring depression (depression scale from Slovene version of Trauma Symptom Checklist for Children) and diabetes distress (Diabetes Distress Screening Scale). Six additional items were included to assess the fear of hypoglycemia and family support. Socio-demographic and diabetes-related data were collected. Questionnaires were analyzed by a psychologist, and the patients that scored above cut-off point were invited to an individual psychological assessment.

Results

Of the sample, 1.3 % reached the threshold for elevated depressive symptoms, and 32.7 % reported significant diabetes distress. The need for psychological support from a specialist was expressed by 5.0 %. There were statistically significant associations between all psychological variables; moreover, better glycemic control was associated with lower diabetes distress and better family support. Nine patients (5.7 %) started with psychological treatment according to the referrals after screening.

Conclusions

The results after one year of psychological screening in Slovene type 1 diabetes population displayed small rates of depression and a large proportion of diabetes distress. Only a small percentage of patients attended the offered individual psychological assessment.     

控制糖化血红蛋白在儿童糖尿病中的临床应用

目的:观察糖尿病患儿糖化红血蛋白(HbA1c)控制情况,了解其在糖尿病控制中的应用价值。方法:选取2009年1月1日～12月31日已确诊的糖尿病在北京儿童医院内分泌科复诊的患儿591例,检测其HbA1c水平。按性别分为男、女两组;按发育情况分为青春前期组和青春发育期组;按HbA1c的控制情况,在年龄分组的基础上分为控制理想、可接受、较差、差4组。用SPSS软件进行统计学分析。结果:男性患儿的HbA1c平均水平为(8.81±4.24)%,女性患儿的HbA1c平均水平为(8.77±3.77)%;不同性别之间HbA1c水平差异无统计学意义(P>0.05)。青春前期组的HbA1c平均水平为(7.97±1.60)%;青春发育期HbA1c平均水平为(9.28±2.47)%,两个年龄组之间差异有统计学意义(P<0.01),青春发育期HbA1c水平明显高于青春前期组。青春前期组患儿HbA1c控制较理想的比例明显高于青春发育期组(P<0.05),青春发育期组患儿HbA1c控制差的比例明显高于青春前期组(P<0.01)。结论:青春前期组的患儿因由家长监督依从性较好,HbA1c水平控制较好,青春发育期组的糖尿病患儿应加强糖尿病知识的健康教育,加强精神心理方面的治疗,制定个性化的治疗方案,减少并发症。     

Psychological comorbidity in patients with cancer

In western industrial nations, cancer is one of the most frequent somatic diseases showing increasing incidence rates. Although the options for medical treatment and the survival rates for most cancer diagnoses have improved over the last few decades, cancer is still a life-threatening illness associated with psychosocial issues, suffering, and distress. Depending on the severity and duration of symptoms, psychosocial distress due to cancer ranges from normal reactions to psychological comorbidity based on ICD classification criteria. In cancer patients, the most frequent psychological diagnoses are adjustment disorders, anxiety, and depression; prevalence rates in the literature show high variations depending on the tumor type studied and the assessment instrument used. Today, standardized and validated screening instruments and diagnostic interviews are available for the screening and assessment of psychosocial distress and psychiatric comorbidity. The screening of psychosocial distress in cancer patients and the assessment of psychiatric disorders are important tasks of modern cancer treatment in order to determine the need for psychosocial counseling and psychooncological treatment.     

The Relation Between Parental Psychological Distress and Adolescent Anxiety in Youths With Chronic Illnesses: The Mediating Effect of Perceived Child Vulnerability

The purpose of this study was to examine the relation of perceived child vulnerability (PCV) and parental psychological distress (PPD) to adolescent anxiety (AANX) in youths with chronic illnesses. Ninety-one (n = 91) adolescents diagnosed with either type 1 diabetes mellitus (DM1) or asthma and their parents were recruited as part of a larger study examining parent and child adjustment to chronic illness. Adolescents completed a measure of anxiety, and parents completed measures of PCV and PPD. After controlling for multiple demographic and illness parameters, both PPD and PCV significantly predicted AANX. Further analysis indicated that the relation between PPD and AANX was mediated by PCV. These findings suggest that parent-reported psychological distress is associated with adolescent-reported anxiety. Notably, PCV appears to be a possible mechanism by which PPD influences anxiety in adolescents with chronic illnesses. Clinical relevance, study limitations, directions for future research, and implications for practice are discussed.     

Psychosocial characteristics of diabetic students at Sporting Students Hospital in Alexandria

Type 1 diabetes mellitus is a chronic disease that may have an impact on children's psychosocial adjustment. The aim of the present work was to study the psychosocial characteristics of diabetic students and to determine predictors of diabetes control. A cross-sectional study of 150 diabetic students who attended the diabetic school health insurance clinic of Sporting Student's Hospital in Alexandria governorate within a period of one month was conducted. A pre-designed interviewing questionnaire was used to collect--from the child and/or his/her parents--personal data, data about the child social relationships and school and disease characteristics. School adjustment index and stress symptom index were used to assess the school performance and the stress symptoms respectively. The result revealed that 34% of the diabetic students were maladjusted to school and 31.3% were symptomatic based on the stress index. Generally speaking, diabetic children reported good relationship to peers (65.3%), parents (57.3%) and siblings (51.3%), most of them have good friendship (82%) and those involved in one or more kind of hobby were about three fourth of all. Both age (P<0.05), sex (P<0.05), social class (P<0.05), disease duration (P<0.05) and stress symptoms (P<0.05) were all significantly associated with the disease control. However after adjustment for other variables, students of low social class families (OR=5.1, p<0.01) and those of longer disease duration (6-10 years) (OR=7.9, p<0.05) were significant predictors of diabetes control. In conclusion diabetes per se might have no significant association with academic performance or social relationship. Students with large diabetic duration-especially those of low social class families--are at increased risk of suboptimal glycaemic control and should be targeted for interventional strategies.     

Cardiovascular disease risk factors and psychological distress among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Studies show that cardiovascular disease (CVD) risk factors are correlated with psychological distress, yet research examining these relationships among Hispanic/Latinos is lacking. The population-based Hispanic Community Health Study/Study of Latinos enrolled a cohort of Hispanic/Latino adults (N = 16,415) 18–74 years of age at the time of recruitment, from four US metropolitan areas, between March 2008 and June 2011. Psychological distress (i.e., 10-item Center for Epidemiological Studies Depression Scale, 10 item Spielberger Trait Anxiety Scale, and a combined depression/anxiety score), socio-demographics (i.e., age, education, income, insurance, sex, and Hispanic/Latino background), acculturation (i.e., country of birth and language preference), and traditional CVD risk factors (i.e., dyslipidemia, obesity, current cigarette smoking, diabetes, and hypertension) were assessed at baseline. Associations between CVD risk factors and psychological distress measures by sex were examined using multiple linear regression models, accounting for complex survey design and sampling weights and controlling for socio-demographic and acculturation covariates. In adjusted analyses, all three psychological distress measures were significantly related to smoking. For females, greater psychological distress was significantly related to obesity and current smoking. For males, diabetes and current smoking were associated with psychological distress. For males and females, dyslipidemia and hypertension were not associated with psychological distress after adjusting for other factors. Elevated depression and anxiety symptoms were associated with CVD risk factors for Hispanic/Latino men and women. However, these results were not consistent across Hispanic/Latino groups. As promoted by the integrative care model, psychosocial concerns should be considered in research on CVD risk and chronic disease prevention.